The development of sinus augmentation procedures has diminished the problem of proper implant placement in the posterior maxilla in patients that have a pneumatized maxillary sinus and reduced alveolar bone. The gold standard approach to augmentation-the external sinus augmentation-was developed years ago and is still touted as the best approach for creating maxillary posterior bone. However, external sinus augmentation procedures are often quite traumatic, time-consuming, and costly, and they have anatomical limitations and considerable documented morbidity. This article discusses the external procedure and contrasts it with an internal sinus augmentation with osteotomes that is as effective in promoting sinus augmentation, is localized and relatively atraumatic, can be performed rapidly, is reasonable in cost, and has negligible morbidity. In addition, a modification of future site development augmentation, in preparation for secondary implant placement, is described, as are three cases, to demonstrate the impressive augmentation that can be achieved with osteotome sinus elevation. Schlagwörter: dental implant, external sinus augmentation, internal sinus augmentation, osteotomes, sinus elevation